Ingredient Approach Research Articles

Multiple Functional Ingredient Approach in Formulating Dietary Supplement for Management of Diabetes: A Review

Food and nutrition science has moved from identifying and correcting nutritional deficiencies to designing foods that promote optimal health and reduce the risk of disease. Diabetes is rapidly emerging as a pandemic. It is also accompanied by several health implications viz. cardiovascular diseases, obesity, hypertension, cancer, depression, and eating disorders. International Diabetes Federation estimates that in 2010, India is home to 50.8 million diabetics and the number is expected to go up to a whopping 87 million by 2030. The primary goal of medical nutrition therapy was to design special dietary products for patients with hyperglycemia, intended in controlling postprandial plasma glucose fluctuations and hypercholesterolemic tendencies. However, an effective way to minimize these health risks could be through modifications in the diet by inclusion of multiple functional ingredients, aimed for their concerted role in management of individuals suffering with diabetes.

Impact of dropout of female volunteer community health workers: an exploration in Dhaka urban slums.

BackgroundThe model of volunteer community health workers (CHWs) is a common approach to serving the poor communities in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in this area, has been using female CHWs as core workers in its community-based health programs since 1977. After 25 years of implementing of the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through a community-based maternal health intervention. However, BRAC experiences high dropout rates among CHWs suggesting a need to better understand the impact of their dropout which would help to reduce dropout and increase program sustainability. The main objective of the study was to estimate impact of dropout of volunteer CHWs from both BRAC and community perspectives. Also, we estimated cost of possible strategies to reduce dropout and compared whether these costs were more or less than the costs borne by BRAC and the community.MethodsWe used the ‘ingredient approach’ to estimate the cost of recruiting and training of CHWs and the so-called ‘friction cost approach’ to estimate the cost of replacement of CHWs after adapting. Finally, we estimated forgone services in the community due to CHW dropout applying the concept of the friction period.ResultsIn 2009, average cost per regular CHW was US$ 59.28 which was US$ 60.04 for an ad-hoc CHW if a CHW participated a three-week basic training, a one-day refresher training, one incentive day and worked for a month in the community after recruitment. One month absence of a CHW with standard performance in the community meant substantial forgone health services like health education, antenatal visits, deliveries, referrals of complicated cases, and distribution of drugs and health commodities. However, with an additional investment of US$ 121 yearly per CHW BRAC could save another US$ 60 invested an ad-hoc CHW plus forgone services in the community.ConclusionAlthough CHWs work as volunteers in Dhaka urban slums impact of their dropout is immense both in financial term and forgone services. High cost of dropout makes the program less sustainable. However, simple and financially competitive strategies can improve the sustainability of the program.

The Cost of Providing HIV/AIDS Counseling and Testing Services in Vietnam

ObjectiveThis article aimed to provide estimates and analyses of the cost of providing voluntary counseling and testing (VCT) services for HIV/AIDS in a province in northern Vietnam. MethodsThis facility-based costing study was conducted in the Thai Nguyen province, located 85 km north of Hanoi. Cost data were collected in six facility-based VCT units and two freestanding ones by using an ingredient approach. Both financial and economic costs of VCT services for HIV/AIDS were estimated from the perspective of the service providers. ResultsThe mean total annual financial costs of a facility-based and a freestanding VCT unit in the study site were US $15,673 and US $42,237, respectively. The mean total annual economic costs of these services were US $16,695 and US $44,682, respectively. The cost per visit to the facility-based VCT unit was lower than in the freestanding facility (financial cost of US $28.4 vs. US $36.8; economic cost of US $30.3 vs. US $38.9). The same was true for the cost per complete VCT procedure (financial cost of US $34.7 vs. US $38.0; economic cost of US $36.9 vs. US $40.2). The cost per HIV positive case detected in facility-based VCT unit was higher than that of the freestanding VCT unit (financial cost of US $149.3 vs. US $111.2; economic cost of US $159.0 vs. US $117.6). ConclusionsThe results of the present study offer preliminary evidence on economic aspects of providing VCT services in Vietnam. The findings from this study can serve as a basis for further studies as well as for program and policy development.

Coverage, Adherence and Costs of Intermittent Preventive Treatment of Malaria in Children Employing Different Delivery Strategies in Jasikan, Ghana

BackgroundIntermittent preventive treatment of malaria in children (IPTc) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxine-pyrimethamine plus amodiaquine (SP&AQ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy.MethodsA community randomized trial was undertaken in Jasikan district, Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways. Twelve villages were randomly selected to receive IPTc from village health workers (VHWs) or facility-based nurses working at health centres' outpatient departments (OPD) or EPI outreach clinics. Children aged 3 to 59 months-old received one IPT course (three doses) in May, June, September and October. Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective.ResultsThe economic cost per child receiving at least the first dose of all 4 courses was US$4.58 when IPTc was delivered by VHWs, US$4.93 by OPD nurses and US$ 5.65 by EPI nurses. The unit economic cost of receiving all 3 doses of all 4 courses was US$7.56 and US$8.51 when IPTc was delivered by VHWs or facility-based nurses respectively. The main cost driver for the VHW delivery was supervision, reflecting resources used for travelling to more remote communities rather than more intense supervision, and for OPD and EPI delivery, it was the opportunity cost of the time spent by nurses in dispensing IPTc.ConclusionsVHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district, Ghana.Trial RegistrationClinicalTrials.gov NCT00119132.

Cost recovery of NGO primary health care facilities: a case study in Bangladesh

BackgroundLittle is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG) targets the financial sustainability of such facilities is crucial.MethodsThe study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value). Sensitivity analysis was done using 3% discount rate.ResultsThe cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient.ConclusionThe cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase utilization, efficient planning, resource allocation and their optimum use. It also requires controlling variable costs and preventing any wastage of resources.

Cost of providing the expanded programe on immunization: findings from a facility-based study in Viet Nam, 2005

To estimate and analyse the costs for providing the expanded programme on immunization (EPI) in a rural community in the north of Viet Nam in 2005. An ingredient approach was used to collect cost data from the perspective of the service providers. The total annual cost of EPI in Bavi district was US$58,460 [purchasing power parity (PPP) 282,076]. Vaccines and supplies were the largest cost category (33%), followed by personnel costs (30.2%). The largest share of the total cost was due to activities at commune level (38%). The average cost per fully vaccinated child (FVC) was US$4.81 (PPP 23.21), much lower than the figure of US$15 that is generally accepted as the cost-effective threshold for EPI in developing countries. This empirical study indicates that EPI has been implemented efficiently in rural Viet Nam, but that opportunities exist to make it even more efficient.

Costs of patient management of visceral leishmaniasis in Muzaffarpur, Bihar, India

To identify and quantify the direct and indirect economic cost of treatment for visceral leishmaniasis (VL) with conventional Amphotericin B deoxycholate, currently the first-line treatment in Muzaffarpur. Costs of patient management for VL were estimated from a societal and household perspective by means of a questionnaire designed for this study, interviews and financial reports. The total cost of care per episode of VL from the societal perspective was estimated at US$355, equivalent to 58% of annual household income. The largest cost category was medical costs (55%), followed by indirect costs (36%) and non-medical costs (9%). The cost from the household perspective was equivalent to US$217. The largest cost category was indirect costs (59%), followed by medical costs (27%) and non-medical costs (15%). Loss of income because of illness and hospitalization and expenses for drugs were the largest cost components. The economic costs related to VL are substantial, both to society and the patient. Public health authorities in Bihar should focus on policies that detect VL in the early stage and implement interventions that minimize the burden to households affected by VL.

Inhibition of Vibrio parahaemolyticus in seafood systems using oregano and cranberry phytochemical synergies and lactic acid

Several food additives are used to extend the shelf life of food, and delay or inhibit the growth of pathogenic microorganisms. Extracts of plants, particularly herbs and spices, are rich in essential oils and phenolic secondary metabolites and several possess antimicrobial activity. Some of these plant extracts are used in the aroma and flavor industry, and are classified as “generally regarded as safe” (GRAS). Oregano and cranberry extract mix provide a GRAS-type phytochemical source with the potential to develop a natural and effective antimicrobial strategy against Vibrio parahaemolyticus. Different ratios of extract mixtures were optimized from oregano and cranberry, and evaluated for antimicrobial activity in laboratory medium and seafood products. The results indicated that the antimicrobial activity was enhanced in response to extract mixtures than individual extracts of each species. The efficacy was further improved by combination with lactic acid, which is also considered GRAS. These results show the potential of plant extracts to be antimicrobial and, when combined with lactic acid, they can be used as a more effective multiple-barrier food preservation system. Such a synergistic ingredient approach can have wide implications for improvement of food safety. Industrial relevance Phenolic phytochemicals are excellent sources of antioxidants and antimicrobials in the diet, which contribute positively to the management of oxidation-linked and infectious diseases. Traditionally, individual phenolics have been targeted as antimicrobials with low efficacy. In this manuscript, we have shown how mixtures of phenolic phytochemicals from cranberry and oregano, in synergistic combination with lactic acid, can inhibit V. parahaemolyticus in seafood systems. Such a strategy can be used for enhancing food safety in food industry.